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Fernández-de-las-Peñas C, Raveendran AV, Giordano R, Arendt-Nielsen L. Long COVID or Post-COVID-19 Condition: Past, Present and Future Research Directions. Microorganisms 2023; 11:2959. [PMID: 38138102 PMCID: PMC10745830 DOI: 10.3390/microorganisms11122959] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2023] [Revised: 12/02/2023] [Accepted: 12/09/2023] [Indexed: 12/24/2023] Open
Abstract
The presence of symptoms after an acute SARS-CoV-2 infection (long-COVID) has become a worldwide healthcare emergency but remains underestimated and undertreated due to a lack of recognition of the condition and knowledge of the underlying mechanisms. In fact, the prevalence of post-COVID symptoms ranges from 50% during the first months after the infection up to 20% two-years after. This perspective review aimed to map the existing literature on post-COVID symptoms and to identify gaps in the literature to guide the global effort toward an improved understanding of long-COVID and suggest future research directions. There is a plethora of symptomatology that can be due to COVID-19; however, today, there is no clear classification and definition of this condition, termed long-COVID or post-COVID-19 condition. The heterogeneity in the symptomatology has led to the presence of groups/clusters of patients, which could exhibit different risk factors and different mechanisms. Viral persistence, long-lasting inflammation, immune dysregulation, autoimmune reactions, reactivation of latent infections, endothelial dysfunction and alteration in gut microbiota have been proposed as potential mechanisms explaining the complexity of long-COVID. In such an equation, viral biology (e.g., re-infections, SARS-CoV-2 variants), host biology (e.g., genetics, epigenetics) and external factors (e.g., vaccination) should be also considered. These various factors will be discussed in the current perspective review and future directions suggested.
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Affiliation(s)
- César Fernández-de-las-Peñas
- Department of Physical Therapy, Occupational Therapy, Physical Medicine and Rehabilitation, Universidad Rey Juan Carlos, 28922 Madrid, Spain
- Center for Neuroplasticity and Pain (CNAP), Center for Sensory-Motor Interaction (SMI), Department of Health Science and Technology, Faculty of Medicine, Aalborg University, DK-9220 Aalborg, Denmark; (R.G.); (L.A.-N.)
| | | | - Rocco Giordano
- Center for Neuroplasticity and Pain (CNAP), Center for Sensory-Motor Interaction (SMI), Department of Health Science and Technology, Faculty of Medicine, Aalborg University, DK-9220 Aalborg, Denmark; (R.G.); (L.A.-N.)
| | - Lars Arendt-Nielsen
- Center for Neuroplasticity and Pain (CNAP), Center for Sensory-Motor Interaction (SMI), Department of Health Science and Technology, Faculty of Medicine, Aalborg University, DK-9220 Aalborg, Denmark; (R.G.); (L.A.-N.)
- Department of Medical Gastroenterology, Mech-Sense, Aalborg University Hospital, DK-9000 Aalborg, Denmark
- Steno Diabetes Center North Denmark, Clinical Institute, Aalborg University Hospital, DK-9000 Aalborg, Denmark
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Bassanello M, Geppini R, Bonsembiante E, Coli U, Farencena A, D’Aquino M, Gambaro A, Buja A, Baldovin T. Risk of SARS-CoV-2 transmission in the close contacts in a small rural area in the Veneto Region (NE-Italy): past evidence for future scenarios. Front Public Health 2023; 11:1223109. [PMID: 37732097 PMCID: PMC10507707 DOI: 10.3389/fpubh.2023.1223109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Accepted: 08/14/2023] [Indexed: 09/22/2023] Open
Abstract
Background During the first pandemic phase of COVID-19, an epidemiological study, named First survey, was conducted on the population of a small rural area in northern Italy. In spring 2020, the results showed how a prolonged lockdown slowed down the spread of the virus. Methods After contacting positive First Survey subjects and their families, those who decided to join voluntarily underwent a blood test to assess the presence of qualitative lgG about 2 months after the previous one. This was to determine if IgG persisted in individuals who tested positive in the First Survey as well as to assess the antibody status of their close family members, to determine if they were unintentionally infected. Results Based on serological analysis, 35.1% of the samples contained blood IgG. In subjects who tested positive during the First Survey, 62.5% remained IgG positive more than 2 months later. Among family members who were exposed to a positive relative, 23.7% were infected. Linear regression analysis showed that the presence of an infected person within a household resulted in the infection spreading to the others, but not excessively. Induced isolation extinguished the infection regardless of the extent of the contagion (intra-family or extra-family). Micro-outbreaks of SARS-Cov-2 infection which arose in the same household from extra-familial infections played a decisive role on the statistical significance of IgG-positive subjects (p < 0.001). Discussion The study reveal 52.6% of the IgG-positive subjects in the Second Survey came from the First Survey and 47.4% were family members previously in contact with positive subjects. Data suggest that there have been undiagnosed patients feeding the spread of the virus since the beginning of the pandemic. In conclusion, for future pandemics, it will be necessary: i) to ensure the rapid isolation of symptomatic patients and the early identification of their close contacts, ii) to carry out the maximum number of tests in the shortest possible time, both on symptomatic and asymptomatic subjects, and iii) to implement information campaigns to make people aware of their risks, and implement clear, non-conflicting communication.
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Affiliation(s)
- Marco Bassanello
- Emergency and Health Department, Monastier di Treviso Hospital, Treviso, Italy
- Hygiene and Public Health Unit, Department of Cardiac, Thoracic and Vascular Sciences, School of Medicine and Surgery, University of Padua, Padua, Italy
| | - Ruggero Geppini
- Hygiene and Public Health Unit, Department of Cardiac, Thoracic and Vascular Sciences, School of Medicine and Surgery, University of Padua, Padua, Italy
| | | | - Ugo Coli
- Health Department, Monastier di Treviso Hospital, Treviso, Italy
| | - Aldo Farencena
- Laboratory and Microbiology Monastier di Treviso Hospital, Treviso, Italy
| | | | - Andrea Gambaro
- Department of Environmental Sciences, Informatics and Statistics (DAIS), Ca’ Foscari University of Venice, Venice, Italy
| | - Alessandra Buja
- Hygiene and Public Health Unit, Department of Cardiac, Thoracic and Vascular Sciences, School of Medicine and Surgery, University of Padua, Padua, Italy
| | - Tatjana Baldovin
- Hygiene and Public Health Unit, Department of Cardiac, Thoracic and Vascular Sciences, School of Medicine and Surgery, University of Padua, Padua, Italy
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Goretzki SC, Brasseler M, Dogan B, Hühne T, Bernard D, Schönecker A, Steindor M, Gangfuß A, Della Marina A, Felderhoff-Müser U, Dohna-Schwake C, Bruns N. High Prevalence of Alternative Diagnoses in Children and Adolescents with Suspected Long COVID-A Single Center Cohort Study. Viruses 2023; 15:579. [PMID: 36851793 PMCID: PMC9961131 DOI: 10.3390/v15020579] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 01/31/2023] [Accepted: 02/18/2023] [Indexed: 02/22/2023] Open
Abstract
BACKGROUND Long COVID (LC) is a diagnosis that requires exclusion of alternative somatic and mental diseases. The aim of this study was to examine the prevalence of differential diagnoses in suspected pediatric LC patients and assess whether adult LC symptom clusters are applicable to pediatric patients. MATERIALS AND METHODS Pediatric presentations at the Pediatric Infectious Diseases Department of the University Hospital Essen (Germany) were assessed retrospectively. The correlation of initial symptoms and final diagnoses (LC versus other diseases or unclarified) was assessed. The sensitivity, specificity, negative and positive predictive values of adult LC symptom clusters were calculated. RESULTS Of 110 patients, 32 (29%) suffered from LC, 52 (47%) were diagnosed with alternative somatic/mental diseases, and 26 (23%) remained unclarified. Combined neurological and respiratory clusters displayed a sensitivity of 0.97 (95% CI 0.91-1.00) and a negative predictive value of 0.97 (0.92-1.00) for LC. DISCUSSION/CONCLUSIONS The prevalence of alternative somatic and mental diseases in pediatric patients with suspected LC is high. The range of underlying diseases is wide, including chronic and potentially life-threatening conditions. Neurological and respiratory symptom clusters may help to identify patients that are unlikely to be suffering from LC.
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Affiliation(s)
- Sarah C. Goretzki
- Department of Pediatrics I, Neonatology, Pediatric Intensive Care, Pediatric Infectiology, Pediatric Neurology, University Duisburg-Essen, Children’s Hospital Essen, 45147 Essen, Germany
- Center for Translational Neuro- and Behavioral Sciences C-TNBS, University Duisburg-Essen, 45147 Essen, Germany
- West German Centre for Infectious Diseases (WZI), University Hospital Essen, University Duisburg-Essen, 45147 Essen, Germany
| | - Maire Brasseler
- Department of Pediatrics I, Neonatology, Pediatric Intensive Care, Pediatric Infectiology, Pediatric Neurology, University Duisburg-Essen, Children’s Hospital Essen, 45147 Essen, Germany
- Center for Translational Neuro- and Behavioral Sciences C-TNBS, University Duisburg-Essen, 45147 Essen, Germany
- West German Centre for Infectious Diseases (WZI), University Hospital Essen, University Duisburg-Essen, 45147 Essen, Germany
| | - Burcin Dogan
- Department of Pediatrics I, Neonatology, Pediatric Intensive Care, Pediatric Infectiology, Pediatric Neurology, University Duisburg-Essen, Children’s Hospital Essen, 45147 Essen, Germany
- West German Centre for Infectious Diseases (WZI), University Hospital Essen, University Duisburg-Essen, 45147 Essen, Germany
| | - Tom Hühne
- Department of Pediatrics I, Neonatology, Pediatric Intensive Care, Pediatric Infectiology, Pediatric Neurology, University Duisburg-Essen, Children’s Hospital Essen, 45147 Essen, Germany
| | - Daniel Bernard
- Department of Pediatrics I, Neonatology, Pediatric Intensive Care, Pediatric Infectiology, Pediatric Neurology, University Duisburg-Essen, Children’s Hospital Essen, 45147 Essen, Germany
| | - Anne Schönecker
- Department of Pediatrics III, Pediatric Pulmonology and Sleep Medicine, University Duisburg-Essen, Children’s Hospital Essen, 45147 Essen, Germany
| | - Mathis Steindor
- Department of Pediatrics III, Pediatric Pulmonology and Sleep Medicine, University Duisburg-Essen, Children’s Hospital Essen, 45147 Essen, Germany
| | - Andrea Gangfuß
- Department of Pediatrics I, Neonatology, Pediatric Intensive Care, Pediatric Infectiology, Pediatric Neurology, University Duisburg-Essen, Children’s Hospital Essen, 45147 Essen, Germany
- Center for Translational Neuro- and Behavioral Sciences C-TNBS, University Duisburg-Essen, 45147 Essen, Germany
| | - Adela Della Marina
- Department of Pediatrics I, Neonatology, Pediatric Intensive Care, Pediatric Infectiology, Pediatric Neurology, University Duisburg-Essen, Children’s Hospital Essen, 45147 Essen, Germany
- Center for Translational Neuro- and Behavioral Sciences C-TNBS, University Duisburg-Essen, 45147 Essen, Germany
| | - Ursula Felderhoff-Müser
- Department of Pediatrics I, Neonatology, Pediatric Intensive Care, Pediatric Infectiology, Pediatric Neurology, University Duisburg-Essen, Children’s Hospital Essen, 45147 Essen, Germany
- Center for Translational Neuro- and Behavioral Sciences C-TNBS, University Duisburg-Essen, 45147 Essen, Germany
| | - Christian Dohna-Schwake
- Department of Pediatrics I, Neonatology, Pediatric Intensive Care, Pediatric Infectiology, Pediatric Neurology, University Duisburg-Essen, Children’s Hospital Essen, 45147 Essen, Germany
- Center for Translational Neuro- and Behavioral Sciences C-TNBS, University Duisburg-Essen, 45147 Essen, Germany
- West German Centre for Infectious Diseases (WZI), University Hospital Essen, University Duisburg-Essen, 45147 Essen, Germany
| | - Nora Bruns
- Department of Pediatrics I, Neonatology, Pediatric Intensive Care, Pediatric Infectiology, Pediatric Neurology, University Duisburg-Essen, Children’s Hospital Essen, 45147 Essen, Germany
- Center for Translational Neuro- and Behavioral Sciences C-TNBS, University Duisburg-Essen, 45147 Essen, Germany
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Buonsenso A, Murri A, Centorbi M, Di Martino G, Calcagno G, di Cagno A, Fiorilli G, Iuliano E. Psychological Wellbeing and Perceived Fatigue in Competitive Athletes after SARS-CoV-2 Infection 2 Years after Pandemic Start: Practical Indications. J Funct Morphol Kinesiol 2022; 8:jfmk8010001. [PMID: 36648893 PMCID: PMC9844459 DOI: 10.3390/jfmk8010001] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Revised: 12/15/2022] [Accepted: 12/16/2022] [Indexed: 12/24/2022] Open
Abstract
The COVID-19 pandemic deeply affected sports and athletes, influencing performance and psychological wellbeing. In order to provide useful guidelines for coaches, a web-based survey was conducted. Three web-based questionnaires were administered during the last phase of the Omicron wave to a total of 204 Italian athletes (age 24.96 ± 9.82): an informative questionnaire to collect sociodemographic data and infection symptoms information, the Fatigue Severity Scale (FSS) and the General Health Questionnaire-12 (GHQ-12). No differences between infection sequels of different variant typologies were found over the long term after the infection. The most frequently declared symptoms included cough (50%), muscular skeletal impairments (48%) fatigue (43%) and fever (43%). Results showed that female athletes have a higher risk of developing post-COVID-19 symptoms, GHQ-12 worse results (p = 0.005) and greater fatigue (p = 0.0002) than males. No significant difference in infection incidence between high- and low-level athletes was found. Endurance athletes showed greater perceived fatigue than anaerobic sports athletes (p = 0.045). Conclusions: These results suggested the need for specific approaches and continuous updating to differentiate training programs for different athletes during the return to play. Medical controls and daily monitoring of athletes of all levels after the infection could be advisable.
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Affiliation(s)
- Andrea Buonsenso
- Department of Medicine and Health Sciences, University of Molise, v. De Sanctis 1, 86100 Campobasso, Italy
| | - Arianna Murri
- Department of Motor, Human and Health Sciences, University of Rome “Foro Italico”, Lauro de Bosis Square 15, 00197 Rome, Italy
| | - Marco Centorbi
- Department of Medicine and Health Sciences, University of Molise, v. De Sanctis 1, 86100 Campobasso, Italy
| | - Giulia Di Martino
- Department of Medicine and Health Sciences, University of Molise, v. De Sanctis 1, 86100 Campobasso, Italy
| | - Giuseppe Calcagno
- Department of Medicine and Health Sciences, University of Molise, v. De Sanctis 1, 86100 Campobasso, Italy
| | - Alessandra di Cagno
- Department of Motor, Human and Health Sciences, University of Rome “Foro Italico”, Lauro de Bosis Square 15, 00197 Rome, Italy
- Correspondence: ; Tel.: +39-3343176709
| | - Giovanni Fiorilli
- Department of Medicine and Health Sciences, University of Molise, v. De Sanctis 1, 86100 Campobasso, Italy
| | - Enzo Iuliano
- Department of Theoretical and Applied Sciences, eCampus University, 22060 Novedrate, Italy
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5
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Notarte KI, de Oliveira MHS, Peligro PJ, Velasco JV, Macaranas I, Ver AT, Pangilinan FC, Pastrana A, Goldrich N, Kavteladze D, Gellaco MML, Liu J, Lippi G, Henry BM, Fernández-de-las-Peñas C. Age, Sex and Previous Comorbidities as Risk Factors Not Associated with SARS-CoV-2 Infection for Long COVID-19: A Systematic Review and Meta-Analysis. J Clin Med 2022; 11:jcm11247314. [PMID: 36555931 PMCID: PMC9787827 DOI: 10.3390/jcm11247314] [Citation(s) in RCA: 67] [Impact Index Per Article: 33.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Revised: 11/21/2022] [Accepted: 12/05/2022] [Indexed: 12/13/2022] Open
Abstract
Identification of predictors of long COVID-19 is essential for managing healthcare plans of patients. This systematic literature review and meta-analysis aimed to identify risk factors not associated with Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) infection, but rather potentially predictive of the development of long COVID-19. MEDLINE, CINAHL, PubMed, EMBASE, and Web of Science databases, as well as medRxiv and bioRxiv preprint servers were screened through 15 September 2022. Peer-reviewed studies or preprints evaluating potential pre-SARS-CoV-2 infection risk factors for the development of long-lasting symptoms were included. The methodological quality was assessed using the Quality in Prognosis Studies (QUIPSs) tool. Random-effects meta-analyses with calculation of odds ratio (OR) were performed in those risk factors where a homogenous long COVID-19 definition was used. From 1978 studies identified, 37 peer-reviewed studies and one preprint were included. Eighteen articles evaluated age, sixteen articles evaluated sex, and twelve evaluated medical comorbidities as risk factors of long COVID-19. Overall, single studies reported that old age seems to be associated with long COVID-19 symptoms (n = 18); however, the meta-analysis did not reveal an association between old age and long COVID-19 (n = 3; OR 0.86, 95% CI 0.73 to 1.03, p = 0.17). Similarly, single studies revealed that female sex was associated with long COVID-19 symptoms (n = 16); which was confirmed in the meta-analysis (n = 7; OR 1.48, 95% CI 1.17 to 1.86, p = 0.01). Finally, medical comorbidities such as pulmonary disease (n = 4), diabetes (n = 1), obesity (n = 6), and organ transplantation (n = 1) were also identified as potential risk factors for long COVID-19. The risk of bias of most studies (71%, n = 27/38) was moderate or high. In conclusion, pooled evidence did not support an association between advancing age and long COVID-19 but supported that female sex is a risk factor for long COVID-19. Long COVID-19 was also associated with some previous medical comorbidities.
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Affiliation(s)
- Kin Israel Notarte
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA
| | | | | | | | - Imee Macaranas
- Faculty of Medicine and Surgery, University of Santo Tomas, Manila 1008, Philippines
| | - Abbygail Therese Ver
- Faculty of Medicine and Surgery, University of Santo Tomas, Manila 1008, Philippines
| | | | - Adriel Pastrana
- Faculty of Medicine and Surgery, University of Santo Tomas, Manila 1008, Philippines
| | | | - David Kavteladze
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore, MD 21218, USA
| | | | - Jin Liu
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA
| | - Giuseppe Lippi
- Section of Clinical Biochemistry, University of Verona, 37129 Verona, Italy
| | - Brandon Michael Henry
- Clinical Laboratory, Division of Nephrology and Hypertension, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH 45229, USA
| | - César Fernández-de-las-Peñas
- Department of Physical Therapy, Occupational Therapy, Physical Medicine and Rehabilitation, Universidad Rey Juan Carlos, 28933 Madrid, Spain
- Correspondence: ; Tel.: +34-91-488-88-84
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Reyna-Villasmil E, Caponcello MG, Maldonado N, Olivares P, Caroccia N, Bonazzetti C, Tazza B, Carrara E, Giannella M, Tacconelli E, Rodríguez-Baño J, Palacios-Baena ZR; ORCHESTRA Study. Association of Patients' Epidemiological Characteristics and Comorbidities with Severity and Related Mortality Risk of SARS-CoV-2 Infection: Results of an Umbrella Systematic Review and Meta-Analysis. Biomedicines 2022; 10. [PMID: 36289699 DOI: 10.3390/biomedicines10102437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2022] [Revised: 09/17/2022] [Accepted: 09/19/2022] [Indexed: 11/16/2022] Open
Abstract
The objective of this study was to assess the association between patients’ epidemiological characteristics and comorbidities with SARS-CoV-2 infection severity and related mortality risk. An umbrella systematic review, including a meta-analysis examining the association between patients’ underlying conditions and severity (defined as need for hospitalization) and mortality of COVID-19, was performed. Studies were included if they reported pooled risk estimates of at least three underlying determinants for hospitalization, critical disease (ICU admission, mechanical ventilation), and hospital mortality in patients diagnosed with SARS-CoV-2 infection. Evidence was summarized as pooled odds ratios (pOR) for disease outcomes with 95% confidence intervals (95% CI). Sixteen systematic reviews investigating the possible associations of comorbidities with severity or death from COVID-19 disease were included. Hospitalization was associated with age > 60 years (pOR 3.50; 95% CI 2.97−4.36), smoking habit (pOR 3.50; 95% CI 2.97−4.36), and chronic pulmonary disease (pOR 2.94; 95% CI 2.14−4.04). Chronic pulmonary disease (pOR 2.82; 95% CI 1.92−4.14), cerebrovascular disease (pOR 2.74; 95% CI 1.59−4.74), and cardiovascular disease (pOR 2.44; 95% CI 1.97−3.01) were likely to be associated with increased risk of critical COVID-19. The highest risk of mortality was associated with cardiovascular disease (pOR 3.59; 95% CI 2.83−4.56), cerebrovascular disease (pOR 3.11; 95% CI 2.35−4.11), and chronic renal disease (pOR 3.02; 95% CI 2.61−3.49). In conclusion, this umbrella systematic review provides a comprehensive summary of meta-analyses examining the impact of patients’ characteristics on COVID-19 outcomes. Elderly patients and those cardiovascular, cerebrovascular, and chronic renal disease should be prioritized for pre-exposure and post-exposure prophylaxis and early treatment.
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Lopardo V, Conti V, Montella F, Iannaccone T, Esposito RM, Sellitto C, Manzo V, Maciag A, Ricciardi R, Pagliano P, Puca AA, Filippelli A, Ciaglia E. Gender Differences Associated with the Prognostic Value of BPIFB4 in COVID-19 Patients: A Single-Center Preliminary Study. J Pers Med 2022; 12:1058. [PMID: 35887555 PMCID: PMC9319362 DOI: 10.3390/jpm12071058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Revised: 06/26/2022] [Accepted: 06/26/2022] [Indexed: 11/16/2022] Open
Abstract
In the ongoing global COVID-19 pandemic, male sex is a risk factor for severe disease and death, and the reasons for these clinical discrepancies are largely unknown. The aim of this work is to study the influence of sex on the course of infection and the differences in prognostic markers between genders in COVID-19 patients. Our cohort consisted of 64 adult patients (n = 34 men and n = 30 women) with PCR-proven SARS-CoV-2 infection. Further, a group of patients was characterized by a different severity degree (n = 8 high- and n = 8 low-grade individuals for both male and female patients). As expected, the serum concentrations of LDH, fibrinogen, CRP, and leucocyte count in men were significantly higher than in females. When serum concentrations of the inflammatory cytokines, including IL-6, IL-2, IP-10 and IL-4 and chemokines like MCP-1, were measured with multiplex ELISA, no significant differences between male and female patients were found. In COVID-19 patients, we recently attributed a new prognostic value to BPIFB4, a natural defensin against dysregulation of the immune responses. Here, we clarify that BPIFB4 is inversely related to the disease degree in men but not in women. Indeed, higher levels of BPIFB4 characterized low-grade male patients compared to high-grade ones. On the contrary, no significant difference was reported between low-grade female patients and high-grade ones. In conclusion, the identification of BPIFB4 as a biomarker of mild/moderate disease and its sex-specific activity would open an interesting field for research to underpin gender-related susceptibility to the disease.
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Ramatillah DL, Gan SH, Pratiwy I, Syed Sulaiman SA, Jaber AAS, Jusnita N, Lukas S, Abu Bakar U. Impact of cytokine storm on severity of COVID-19 disease in a private hospital in West Jakarta prior to vaccination. PLoS One 2022; 17:e0262438. [PMID: 35077495 PMCID: PMC8789122 DOI: 10.1371/journal.pone.0262438] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2021] [Accepted: 12/23/2021] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND AND AIM Coronavirus Disease 2019 (COVID-19) has become a worldwide pandemic and is a threat to global health. Patients who experienced cytokine storms tend to have a high mortality rate. However, to date, no study has investigated the impact of cytokine storms. MATERIALS AND METHODS This retrospective cohort study included only COVID-19 positive patients hospitalized in a Private Hospital in West Jakarta between March and September 2020. All patients were not vaccinated during this period and treatment was based on the guidelines by the Ministry of Health Indonesia. A convenience sampling method was used and all patients who met the inclusion criteria were enrolled. RESULTS The clinical outcome of COVID-19 patients following medical therapy was either cured (85.7%) or died (14.3%), with 14.3% patients reported to have cytokine storm, from which 23.1% led to fatalities. A plasma immunoglobulin (Gammaraas®) and/or tocilizumab (interleukin-6 receptor antagonist; Actemra®) injection was utilised to treat the cytokine storm while remdesivir and oseltamivir were administered to ameliorate COVID-19. Most (61.5%) patients who experienced the cytokine storm were male; mean age 60 years. Interestingly, all patients who experienced the cytokine storm had hypertension or/ and diabetes complication (100%). Fever, cough and shortness of breath were also the common symptoms (100.0%). Almost all (92.3%) patients with cytokine storm had to be treated in the intensive care unit (ICU). Most (76.9%) patients who had cytokine storm received hydroxychloroquine and all had antibiotics [1) azithromycin + levofloxacin or 2) meropenam for critically ill patients] and vitamins such as vitamins C and B-complex as well as mineral. Unfortunately, from this group, 23.1% patients died while the remaining 70% of patients recovered. A significant (p<0.05) correlation was established between cytokine storms and age, the presence of comorbidity, diabetes, hypertension, fever, shortness of breath, having oxygen saturation (SPO2) less than 93%, cold, fatigue, ward of admission, the severity of COVID-19 disease, duration of treatment as well as the use of remdesivir, Actemra® and Gammaraas®. Most patients recovered after receiving a combination treatment (oseltamivir + remdesivir + Antibiotics + Vitamin/Mineral) for approximately 11 days with a 90% survival rate. On the contrary, patients who received oseltamivir + hydroxychloroquine + Gammaraas® + antibiotics +Vitamin/Mineral, had a 83% survival rate after being admitted to the hospital for about ten days. CONCLUSION Factors influencing the development of a cytokine storm include age, duration of treatment, comorbidity, symptoms, type of admission ward and severity of infection. Most patients (76.92%) with cytokine storm who received Gammaraas®/Actemra®, survived although they were in the severe and critical levels (87.17%). Overall, based on the treatment duration and survival rate, the most effective therapy was a combination of oseltamivir + favipiravir + hydroxychloroquine + antibiotics + vitamins/minerals.
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Affiliation(s)
- Diana Laila Ramatillah
- Pharmacy Faculty, Universitаs 17 Аgustus 1945 Jаkаrtа, North Jakarta, Indonesia
- * E-mail: ,
| | - Siew Hua Gan
- School of Pharmacy, Monash University Malaysia, Bandar Sunway, Selangor, Malaysia
| | - Ika Pratiwy
- Pharmacy Faculty, Universitаs 17 Аgustus 1945 Jаkаrtа, North Jakarta, Indonesia
| | | | | | - Nina Jusnita
- Pharmacy Faculty, Universitаs 17 Аgustus 1945 Jаkаrtа, North Jakarta, Indonesia
| | - Stefanus Lukas
- Pharmacy Faculty, Universitаs 17 Аgustus 1945 Jаkаrtа, North Jakarta, Indonesia
| | - Usman Abu Bakar
- School of Pharmaceutical Sciences, Universiti Sains Malaysia, Penang, Malaysia
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Fernández-de-Las-Peñas C, Martín-Guerrero JD, Pellicer-Valero ÓJ, Navarro-Pardo E, Gómez-Mayordomo V, Cuadrado ML, Arias-Navalón JA, Cigarán-Méndez M, Hernández-Barrera V, Arendt-Nielsen L. Female Sex Is a Risk Factor Associated with Long-Term Post-COVID Related-Symptoms but Not with COVID-19 Symptoms: The LONG-COVID-EXP-CM Multicenter Study. J Clin Med 2022; 11:413. [PMID: 35054108 DOI: 10.3390/jcm11020413] [Citation(s) in RCA: 128] [Impact Index Per Article: 64.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Revised: 01/11/2022] [Accepted: 01/12/2022] [Indexed: 02/04/2023] Open
Abstract
This multicenter cohort study investigated the differences between coronavirus disease 2019 (COVID-19) related symptoms and post-COVID symptoms between male and female COVID-19 survivors. Clinical and hospitalization data were collected from hospital medical records in a sample of individuals recovered from COVID-19 at five public hospitals in Spain. A predefined list of post-COVID symptoms was systematically assessed, but patients were free to report any symptom. Anxiety/depressive levels and sleep quality were also assessed. Adjusted multivariate logistic regressions were used to identify the association of sex with post-COVID related-symptoms. A total of 1969 individuals (age: 61, SD: 16 years, 46.4% women) were assessed 8.4 months after discharge. No overall significant sex differences in COVID-19 onset symptoms at hospital admission were found. Post-COVID symptoms were present in up to 60% of hospitalized COVID-19 survivors eight months after the infection. The number of post-COVID symptoms was 2.25 for females and 1.5 for males. After adjusting by all variables, female sex was associated with ≥3 post-COVID symptoms (adj OR 2.54, 95%CI 1.671-3.865, p < 0.001), the presence of post-COVID fatigue (adj OR 1.514, 95%CI 1.040-2.205), dyspnea (rest: adj OR 1.428, 95%CI 1.081-1.886, exertion: adj OR 1.409, 95%CI 1.109-1.791), pain (adj OR 1.349, 95%CI 1.059-1.720), hair loss (adj OR 4.529, 95%CI 2.784-7.368), ocular problems (adj OR 1.981, 95%CI 1.185-3.312), depressive levels (adj OR 1.606, 95%CI 1.002-2.572) and worse sleep quality (adj OR 1.634, 95%CI 1.097-2.434). Female sex was a risk factor for the development of some long-term post-COVID symptoms including mood disorders. Healthcare systems should consider sex differences in the management of long haulers.
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Sahu AK, Mathew R, Bhat R, Malhotra C, Nayer J, Aggarwal P, Galwankar S. Steroids use in non-oxygen requiring COVID-19 patients: a systematic review and meta-analysis. QJM 2021; 114:455-463. [PMID: 34347106 DOI: 10.1093/qjmed/hcab212] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 07/27/2021] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Corticosteroids have become the mainstay treatment in severe COVID-19. However, its role is mild disease is controversial due to lack of robust scientific evidence. This systematic review and meta-analysis were conducted to assess effect of steroids in mild COVID-19 patients. METHODS PubMed, EMBASE, Web of Science and medRxiv were searched from 31 December 2019 to 14 May 2021 for studies that reported effectiveness of steroids in non-oxygen requiring COVID-19 patients in terms of progressing to severe disease, mortality, duration of fever, duration of viral clearance and length of hospital stay (LOHS). Studies on inhalational steroids, case reports and reviews were excluded. Risk of bias (ROB) was assessed by the Cochrane's ROB tool and ROBANS tool. Quantitative data synthesis was done using the generic inverse variance method. RESULTS A total of 6411 studies were identified, 2990 articles were screened after exclusion. Seven studies which fit the criteria (involving 2214 non-oxygen requiring COVID-19 patients) were included and analysed. Overall odds of progression to severe disease among the non-oxygen requiring COVID-19 patients receiving steroids was 5.97 [95% confidence interval (CI): 1.27-27.99, I2 = 0%] and odds of death (OR: 1.35, 95% CI: 1.01-1.79; I2 = 0%) as compared to the patients not receiving steroids. Mean duration of fever (7.4 days), duration to viral clearance (18.9 days) and LOHS (20.8 days) were significantly higher in the steroid arm, as compared to that in no-steroid arm (6.7, 16.5 and 15.2 days, respectively). CONCLUSION Steroids in non-oxygen requiring COVID-19 patients can be more detrimental than beneficial. PROTOCOL REGISTRATION The study was prospectively registered in PROSPERO (CRD 42021254951).
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Affiliation(s)
- A K Sahu
- From the Department of Emergency Medicine, All India Institute of Medical Sciences, Ansari Nagar, New Delhi 110049, India
| | - R Mathew
- From the Department of Emergency Medicine, All India Institute of Medical Sciences, Ansari Nagar, New Delhi 110049, India
| | - R Bhat
- From the Department of Emergency Medicine, All India Institute of Medical Sciences, Ansari Nagar, New Delhi 110049, India
| | - C Malhotra
- From the Department of Emergency Medicine, All India Institute of Medical Sciences, Ansari Nagar, New Delhi 110049, India
| | - J Nayer
- From the Department of Emergency Medicine, All India Institute of Medical Sciences, Ansari Nagar, New Delhi 110049, India
| | - P Aggarwal
- From the Department of Emergency Medicine, All India Institute of Medical Sciences, Ansari Nagar, New Delhi 110049, India
| | - S Galwankar
- Department of Emergency Medicine, Sarasota Memorial Hospital, Florida State University, Florida 34230, USA
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LoMauro A, Gervasoni F, Andreoli A, Aliverti A. Respiratory function assessment at the time of a new respiratory virus pandemic. Respir Med 2021; 187:106570. [PMID: 34450474 DOI: 10.1016/j.rmed.2021.106570] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Accepted: 08/06/2021] [Indexed: 02/07/2023]
Abstract
We must be aware that new respiratory virus pandemic can happen frequently. Standard lung function tests should keep their crucial role to assist the clinicians in the decision-making process, but they are at risk for the spread of infection because of the generated droplets. We used opto-electronic plethysmography to investigate the post-COVID-19 syndrome on 12 patients after ICU. We found normal ventilatory pattern at rest, a restrictive pattern located in the ribcage during vital capacity and surgical mask to significantly increase minute ventilation. The attention on unconventional respiratory function tests should be sponsored for the important information they can provide.
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Tashkandi N, Aljuaid M, McKerry T, Alchin J, Taylor L, Catangui EJ, Mulla R, Sinnappan S, Nammour G, El-Saed A, Alshamrani MM. Nursing strategic pillars to enhance nursing preparedness and response to COVID-19 pandemic at a tertiary care hospital in Saudi Arabia. J Infect Public Health 2021; 14:1155-1160. [PMID: 34371365 PMCID: PMC8252703 DOI: 10.1016/j.jiph.2021.06.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2021] [Revised: 06/17/2021] [Accepted: 06/27/2021] [Indexed: 11/24/2022] Open
Abstract
Background COVID-19 pandemic caused enormous implications on the frontline staff. The objective was to share our nursing experience in responding to COVID-19 pandemic at a large hospital and its impact on nursing safety and healthcare services. Methods Six nursing strategic pillars were implemented. Pillar 1: establishing corona command centre. Pillar 2: limiting exposure by virtual care model, strict infection control measures, altered patient flow, active surveillance, and contact tracing. Pillar 3: maintaining sufficient supplies of personal protective equipment. Pillar 4: creating surge capacity by establishing dedicated COVID-19 units and increasing critical care beds. Pillar 5: training and redeployment of nurses and implementing alternate staffing models. Pillar 6: monitoring staff wellbeing, establishing mental health support hotline and clinic, providing hotel self-quarantine, and financial incentives. Results Out of 5483 nurses, 543 (10%) were trained for redeployment, mainly at acute and intensive care units. After serving 11,623 infected patient including 1646 hospitalizations during the first 9 months of the pandemic, only 385 (7.0%) nurses were infected with COVID-19. Out of them, only 10 (2.6%) required hospitalization, one (0.3%) required ICU admission, and none died. Although the number of patients hospitalized at our hospital during the current pandemic was 17 folds higher than the 2015 outbreak of middle East respiratory syndrome coronavirus, the hospital administration did not have to close the hospital as they did in 2015. Conclusions Proactive nursing leadership and implementation of multiple nursing pillars enabled the facility to maintain the safety of nursing workforce while serving large influx of COVID-19 patients.
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Affiliation(s)
- Nabeeha Tashkandi
- Nursing Services, King Abdualziz Medical City (KAMC), Riyadh, Saudi Arabia.
| | - Maha Aljuaid
- Clinical Nursing, Ambulatory and Haemodialysis Care, KAMC, Riyadh, Saudi Arabia
| | | | - John Alchin
- Clinical Nursing, Critical Care, KAMC, Riyadh, Saudi Arabia
| | - Laura Taylor
- Clinical Nursing, Surgical Care, KAMC, Riyadh, Saudi Arabia
| | | | - Rana Mulla
- Nursing Education and Clinical Practice, KAMC, Riyadh, Saudi Arabia
| | - Suwarnnah Sinnappan
- Clinical Nursing, Obstetrical, Gynecological and Neonatal Care, KAMC, Riyadh, Saudi Arabia
| | - Georges Nammour
- Clinical Nursing, Emergency Care, KAMC, Riyadh, Saudi Arabia
| | - Aiman El-Saed
- Infection Prevention and Control, KAMC, Riyadh, Saudi Arabia
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